体重校正腰围指数与高血压患者全因死亡率和心血管死亡率的关联：一项前瞻性队列研究

Association of weight-adjusted-waist index with all-cause and cardiovascular mortality in hypertension: a prospective cohort study.

作者信息

Lan Youmian, Zheng Qiongbing, Lin Chujia, Lin Kun, Chen Yongsong

机构信息

Department of Endocrinology and Metabolism, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.

Department of Rheumatology and Immunology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.

出版信息

BMC Public Health. 2025 Aug 2;25(1):2628. doi: 10.1186/s12889-025-23891-x.

DOI:10.1186/s12889-025-23891-x

PMID:40753426

Abstract

BACKGROUND

With rising obesity and hypertension rates, cardiovascular disease and mortality issues have become increasingly severe. The weight-adjusted waist circumference index (WWI) is an innovative metric that accurately reflects body composition and shows superior potential in predicting obesity-related health risks. This study aims to explore the association between WWI and all-cause and cardiovascular mortality in hypertensive patients.

METHODS

Adult participants with hypertension were included from the National Health and Nutrition Examination Survey (2003-2016). Cox regression models and restricted cubic splines (RCSs) were used to assess the relationship between WWI and mortality. Stratified, interaction, and sensitivity analyses further examined the robustness of the results. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of WWI for mortality.

RESULTS

This study included 14,350 hypertensive individuals. As WWI levels increased, the risk of all-cause and cardiovascular mortality rose progressively. Each one-unit increase in WWI was associated with a 19% higher risk of all-cause mortality and a 23% higher chance of cardiovascular mortality in the fully adjusted continuous model. The highest WWI quartile had an increased risk of all-cause mortality (HR 1.38, 95% CI 1.21-1.57, P for trend < 0.001) and cardiovascular mortality (HR 1.70; 95% CI 1.28-2.25, P for trend = 0.005). Furthermore, RCS analysis revealed a nonlinear association between WWI and all-cause mortality (P-non-linear < 0.001). Stratified and interaction analyses confirmed that these associations were consistent and stable in various demographics, except for the diabetic population. Sensitivity analyses further confirmed these results. ROC analysis indicated that WWI had a higher predictive capability for all-cause and cardiovascular mortality than body mass index, waist circumference, and waist-to-height ratio.

CONCLUSION

This study provides new evidence for the association of WWI with all-cause and cardiovascular mortality in hypertensive patients. WWI may serve as a valuable indicator of adiposity risk in this population.

摘要

背景

随着肥胖率和高血压发病率的上升，心血管疾病和死亡率问题日益严重。体重调整腰围指数（WWI）是一种创新指标，能准确反映身体成分，在预测肥胖相关健康风险方面显示出卓越潜力。本研究旨在探讨高血压患者中WWI与全因死亡率和心血管死亡率之间的关联。

方法

纳入美国国家健康与营养检查调查（2003 - 2016年）中的成年高血压患者。采用Cox回归模型和限制立方样条（RCS）评估WWI与死亡率之间的关系。分层分析、交互作用分析和敏感性分析进一步检验结果的稳健性。构建受试者工作特征（ROC）曲线以评估WWI对死亡率的诊断效能。

结果

本研究纳入了14350名高血压患者。随着WWI水平升高，全因死亡率和心血管死亡率风险逐渐增加。在完全调整的连续模型中，WWI每增加一个单位，全因死亡率风险升高19%，心血管死亡率风险升高23%。WWI最高四分位数组的全因死亡率风险增加（HR 1.38，95%CI 1.21 - 1.57，趋势P < 0.001），心血管死亡率风险增加（HR 1.70；95%CI 1.28 - 2.25，趋势P = 0.005）。此外，RCS分析显示WWI与全因死亡率之间存在非线性关联（P - 非线性 < 0.001）。分层分析和交互作用分析证实，除糖尿病患者群体外，这些关联在不同人口统计学特征中是一致且稳定的。敏感性分析进一步证实了这些结果。ROC分析表明，与体重指数、腰围和腰高比相比，WWI对全因死亡率和心血管死亡率具有更高的预测能力。